ECPR术后血清CitH3与D-二聚体动态变化及预后预测价值OA

Objective The aim of this study was to explore the changes in serum citrullinated histone H3(CitH3)and D-dimer levels after extracorporeal cardiopulmonary resuscitation(ECPR)and their clinical significance.Methods A retrospective study was conducted on 130 patients who underwent ECPR at Zhengzhou Central Hospital from January 2021 to January 2024.The patients were divided into the survival group(n=95)and the death group(n=35)based on their survival status 30 days after the operation.The levels of CitH3 and D-dimer in the serum of the patients were measured before and after the operation,and the characteristics of the changes in CitH3 and D-dimer levels after ECPR were analyzed.The clinical data and CitH3 and D-dimer levels of the two groups were com-pared,and the independent risk factors for death after ECPR were analyzed by Logistic multivariate regression.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of serum CitH3 and D-dimer for death after ECPR.Results Before ECPR,there was no significant difference in the levels of CitH3 and D-dimer in the serum between the survival group and the death group(P>0.05).One hour after the operation,the levels of CitH3 and D-dimer in the serum of both groups increased compared with those before the operation,and continued to increase at 6 hours after the operation,reaching the peak at 12 hours after the opera-tion.After 12 hours,the levels of CitH3 and D-dimer in the serum of the survival group showed a decreasing trend and reached a rela-tively stable level at 48 hours after the operation.The levels of CitH3 and D-dimer in the serum of the death group remained at a high level from 12 hours to 48 hours after the operation,and the levels of CitH3 and D-dimer in the serum of the death group at each time point were higher than those of the survival group(P<0.05).Logistic multivariate regression analysis showed that PCT(OR=2.054),CitH3 at 12 hours after the operation(OR=2.289),and D-dimer at 12 hours after the operation(OR=2.219)were independent risk fac-tors for death after ECPR.The ROC curve showed that the AUC of the combined prediction of CitH3 and D-dimer for death after ECPR was 0.920(95％CI:0.876-0.964),and the sensitivity and specificity were 91.50％and 81.30％,respectively,which were higher than those of a single indicator(P<0.05).Conclusion The levels of CitH3 and D-dimer in the serum are closely related to the prognosis after ECPR,and the combined prediction of CitH3 and D-dimer for death after ECPR has a high efficacy.